Provider Demographics
NPI:1770241796
Name:OJO, OLUBUSAYO
Entity Type:Individual
Prefix:
First Name:OLUBUSAYO
Middle Name:
Last Name:OJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 RED CLAY RD APT 303
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2369
Mailing Address - Country:US
Mailing Address - Phone:202-790-8903
Mailing Address - Fax:
Practice Address - Street 1:275 RED CLAY RD APT 303
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2369
Practice Address - Country:US
Practice Address - Phone:202-790-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-21-195019106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician